The main purpose of this revised proposal is to conduct a prevalence survey to identify the determinants of hypertension (HTN) and target organ damage in black South African men and women. These data will be used subsequently to develop and test sustainable multidisciplinary interventions to improve HTN care and health outcomes. This program of research, a collaboration between the Johns Hopkins University and the Chronic Diseases of Lifestyle Unit of the South African Medical Research Council, is an enhancement and extension of the parent grant NIH # RO1 NR 04119, M.Hill, PI. The survey will be conducted in community health centers, NGO clinics and general practitioners' offices in three black townships near Cape Town. A randomly selected sample of 400 men and women with HTN who have received care in the past 18 months will be recruited: 300 who have continuously received HTN care in the past 6 months and 100 who have not. The final questionnaire, in both English and Xhosa versions, wilt be derived from parent study items, modified and validated for South African cultural relevancy, and piloted. The main hypotheses to be tested is:"BP level, measured as systolic and diastolic BP (and BP control), will be adversely impacted by psychological and behavioral barriers to continuous HTN care, including a. Low HTN knowledge, negative attitudes and beliefs about HTN and non-health-related life priorities; b. Co-morbid conditions such as diabetes, alcohol use, AIDS, and depression; c. Living with orphaned grandchildren, family or friends with catastrophic illnesses such as AIDS; d. Low social support; e. Low health care resources and behavior skills; f. Noncompliance with HTN treatment recommendations including receiving continuous HTN care; and g. Low satisfaction with HTN care. Secondary analyses will examine patterns and trends among 1. Psychosocial and behavioral barriers to care, retention in care, compliance with treatment recommendations, and BP control, and 2. BP level and target organ damage or total CV risk. This study meets the NIH goals of improving the control of disease, enhancing health, and supporting significant innovative research in a supportive environment. In vulnerable black populations in both the US and Africa, it addresses the Fogarty criteria of effective collaboration with an able foreign collaborator, research capacity building, and potential for long-term effectiveness in improving health outcomes.